Exploring the Utilization of and Outcomes from Health Information Exchange in Emergency Settings

Emergency departments (EDs) treat a broad range of patients but often do not have access to patients’ medical records through their local electronic health record (EHR). ED clinicians may require additional information about patients’ medical history from a variety of sources in order to guide clinical decision making and care delivery. To address this, the research team assessed the use and impact of a health information exchange (HIE) system among EDs across multiple hospitals in one State. The HIE system included patient-level data such as demographics, medical histories, and past lab tests and procedures completed offsite, as well as hospital and provider data specific to each ED encounter.

The specific aims of the research were as follows:

• Characterize the use of HIE over time in an emergency setting. 
• Explore the antecedents, motivations for use, and other factors that may influence use of HIE. 
• Examine the association between HIE use, the utilization of healthcare services, and health outcomes among individuals who presented in an emergency setting. 

The research team extracted quantitative data from the HIE system for ED providers who accessed the HIE within a 6 year period. Provider access data were linked to clinical data about each ED encounter, such as the payer, provider’s role, and the rurality of the hospital. These data was analyzed to identify trends in HIE usage over time and the effect of hospital and provider characteristics on HIE use. The research team also conducted semi-structured qualitative interviews with 20 healthcare providers across a range of hospitals, regions, and roles. Participants were asked about their perceptions of HIE, barriers and motivations to using the HIE system, and their knowledge of the HIE system in their hospital.

Overall, HIE usage increased over time as more health systems in the State adopted the HIE system. Clinicians used HIE more frequently when the single sign on feature was introduced, which streamlined the process of looking up patients’ medical records from external sources with just one click within the local EHR system. However, factors such as incomplete information about HIE users in smaller, rural hospitals and lack of provider training on how to use the HIE system contributed to relatively low HIE usage in the ED compared to inpatient settings. Data on the impact of HIE usage on patient health outcomes is pending. Future research should examine the effect of standardized HIE training for providers and whether additional functionalities such as customized user profiles can increase HIE use and impact.